Tag Archives: mental health issues

HEADSSS tool

Using HEADSSS assessment by Dr Emma Parish

In the UK we often discuss our ageing population but sometimes fail to see the significant proportion of those in adolescence, between 12 – 19% of the total UK population in 20171.

Engaging this age group can be daunting for health professionals. HEADSSS is an interview prompt or psychosocial tool to use with young people. Still growing in the consciousness of health professionals (and in the letters making up its acronym) HEADS(SS) was first presented in publication in 19882. It has a reported yield of 1 in 3 for identifying concerns that warrant further investigation.

It follows a simple structure remembered by the acronym:

Home

Education & Employment

Activities

Drugs/Drinking

Sex

Self-harm, depression & suicide

Safety (including social media/online)

The great news is that many studies have shown that self-assessment with HEADSSS tools before discussion (completed at home or in waiting rooms) yields equal, and in some cases more, information than conducting the assessment in person. Helpful for time-strapped clinicians and better utilisation of time for young people attending appointments.

Key tips for using HEADSSS

  • Greet young person first, let them introduce others
  • Practice discussing issues that embarrass you
  • Be clear in what you mean by confidentiality relating to discussion
  • See young people on their own routinely (whenever clinically appropriate)
  • Use linking phrases and questions that don’t presume:
    • Do you have a boyfriend/girlfriend?

Vs

  • Do you have someone important in your life?
  • Have you been in a relationship before? Tell me more…

For more details see the RCPCH Young People’s Health Special Interest Group (YPSIG) app – free to download here: https://app.appinstitute.com/heeadsss

Or this short HEADS-ED assessment tool: http://www.heads-ed.com/en/headsed/HEADSED_Tool_p3751.html

  1. Association of Young People’s Health – Key Statistics Document 2017 download here: http://www.ayph.org.uk/keydata2017/FullVersion2017.pdf
  2. Cohen, E, MacKenzie, R.G., Yates, G.L. (1991). HEADSS, a psychosocial risk assessment instrument: Implications for designing effective intervention programs for runaway youth. Journal of Adolescent Health 12 (7): 539-544.

February 2016

Stepwise management of asthma this month.  Plus some information on infant mental health, paediatric airways and a few more sites on internet safety.  Do leave comments below.

Parent Infant Mental Health

With thanks to Geoff Ferguson, Director of the Parent Infant Centre (www.infantmentalhealth.com) for the following explanation of the Acquarone scales:

The Acquarone Detection Scales for Early Relationships are observational scales that provide a powerful tool for assessing an infant’s capacity to form relationships and a mother’s ability to respond to her infant. The scales have been developed during several decades of clinical practice by Dr Stella Acquarone, who is also the author of several books on infant development and parent infant psychotherapy and Principal of the Parent Infant Clinic.   The Parent Infant Clinic is a private service but does have some subsidised places for families with limited financial resources.

There are two scales, a 25 item scale for observations of the infant and a 13 item scale for observations of the mother. In each case observations are divided into four domains: interpersonal, sensorial, motor and affect. Within each domain observers are asked to note the frequency of certain behaviours. For example, when observing ‘calling’ the observer is looking for ‘facial expressions, noises or gestures that seek to produce an affectionate response from the partner’.

A concern about the infant or the mother might be raised if a particular behaviour was never observed, perhaps showing a difficulty in relating, or was constantly observed, perhaps showing a defensive repetitiveness. The scales can be used to establish a thorough observational benchmark against which later changes can be compared.

Click here to see an example.

 

September 2015 uploaded

September 2015: ENT feature this month – quinsy, Part 2 of the NICE guideline summary on bronchiolitis, information about a domestic violence campaign, self help books for children and a round up of topics to get you started if you are new to paediatric practice.  Do leave comments below.

September 2014 newsletter published

Warts this month, steroids in Bell’s palsy, a recap of the year for the new trainees and some more edicts from NICE on what not to do. A couple of links to good CPD opportunities too. Do leave comments below.

August 2014

August is full of cyclical vomiting, insect bites, asthma plans and NICE “do not do” recommendations.  Do leave comments….

April 2014

More musings from Dr Waterfield this month – this time on paracetamol for immunisation discomfort.  Also the 7 important features of a headache y0u must ask about, a link to a very good paediatric emergency medicine site, NICE quality standards in depression, molluscum contagiosum and more musings from me, this time on paediatric phlebotomy.  Do leave comments below.

February 2014 uploaded

Scabies this month with a beautiful picture of plantar lesions in a child.  Updated NICE head injuries, antipyretics (or not) for febrile convulsions, child trafficking and the last in the sleep series.  Do leave comments below.

Dermatology for the New Year!

Eczema this month, a reminder of treatment of infections and links to some useful audit tools from NICE.  Next month, scabies.  Another excellent website on food and nutrition in toddlers with a bit on do’s and don’ts of faddy eating and a paper on whether treating ADHD reduces crime.  Do leave comments.

Obesity – assessment in secondary care and associated dysmorphisms

Article by Dr Hajera Sheikh, paediatric registrar

Assessment in Secondary Care

History:
• Lifestyle Assessment
• Menstrual History
• Obstructive Sleep Apnoea:  Snoring, difficulty breathing during sleep, morning headaches or fatigue
• Symptoms of co-morbidity including psychological
• Drug use (particularly glucocorticoids and atypical antipsychotics)
• Family history, particularly diabetes <40 yrs, early heart disease <60 yrs
Examination:
• Height, weight, BMI
• Obesity pattern: generalised, central (greater risk of adverse cardiovascular outcomes), buffalo hump and neck (may be suggestive of Cushing syndrome)
• Blood pressure
• Pubertal assessment
• Acanthosis nigricans (indicative of insulin resistance, first seen round neck and axillae)
• Signs of endocrinopathy
• Dysmorphisms: (Look out for early onset obesity, learning difficulties, deafness, epilepsy, retinitis, dysmorphic features, hypogonadism)

Investigations (directed)
• Urinalysis
• Thyroid function
• Fasting lipids (total and HDL cholesterol), triglycerides
• Liver function, including ALT
• Fasting glucose and insulin not usually done first line

Refer to Paediatric Obesity/Endocrinology or other specialist service if further investigation is required

Aetiology
• Genetic studies
• Thyroid studies: T3, thyroid antibodies, calcium, phosphate
• Cushing syndrome investigations

For co-morbidities
• Oral glucose test
• PCOS studies (LH, FSH, adrenal androgens, Sex Hormone Binding Globulin, prolactin, pelvic ultrasound)
• Sleep Study

Dysmorphic and monogenic syndromes associated with obesity:

Main clinical obesity associated syndromes:
• Chromosomal
Prader-Willi syndrome
Trisomy 21
• Autosomal dominant
Biemond syndrome (some cases)
• Autosomal recessive
Aistrom syndrome
Bardet-Biedl syndrome
Biemond Syndrome(some cases)
Carpenter syndrome
Cohen syndrome
• X-linked inheritance
Borjeson-Forssman-Lehmann syndrome
• Single gene lesions affecting leptin metaboilsm
Congenital leptin deficiency
Leptin receptor mutation
Prohormone convertase 1 mutation
Melanocortin 4 mutation

Clinical features suggesting obesity may be secondary to another condition or syndrome
• Severe unremitting obesity
• Disorders of the eyes
Colobomata
Retinal problems, especially retinitis pigmentosa
Narrow palpebral fissures
Abnormally positioned palpebral fissures
Severe squint (eg Prader-Willi)
• Skeletal abnormalities
Polydactyly
Syndactyly
Kyphoscoliosis
• Sensorineural deafness (eg Alstrom syndrome: sensorineural deafness, diabetes mellitus, retinal dystrophy, obesity)
• Microcephaly and/or abnormally shaped skull
• Mental retardation
• Hypotonia
• Hypogonadism
Crptorchidism
Micropenis
Delayed puberty
• Renal abnormalities
• Cardiac abnormalities